Marionette Lines: What They Are and How to Soften Them
BeforeSimulation
- Highlighted area
Quick facts
- What they are
- Lines or folds that run from the corners of the mouth toward the chin.
- Causes
- Loss of volume and support, action of the depressor muscle, laxity, and face shape.
- Options
- Filler, toxin in selected cases, biostimulator, and other approaches, at the professional's discretion.
- Limit
- Soften, not erase. Treating only the line is usually not enough.
Patients look at themselves from the side or the front and see two lines that start at the corners of the mouth and run down like those of a ventriloquist's dummy. The popular name, marionette lines, is true to the image. To them, the lines give an air of sadness or tiredness that does not match how they feel. The question is always the same: can they be softened?
The answer has two parts: yes, in many cases, and almost never with only what is injected into the line. This page explains why and organizes the options. The glossary has the term at marionette lines, and the area is at mouth corner.
What is behind the line?
Marionette lines are not an isolated flaw. They are the result of a set of changes:
- Loss of volume and support: the tissue around the mouth and chin loses fat and firmness, and the area descends.
- Muscle action: the depressor anguli oris muscle pulls the corner of the mouth down, marking the line and the sad look.
- Relationship with the modiolus: the fibromuscular knot at the corner of the mouth is a meeting point for several muscles and influences the shape of the corner.
- Neighboring structures: the jowl (the "sagging cheek" beside the chin) and the prejowl sulcus accentuate the shadow and the line look.
- Skin: loss of elasticity, sun exposure, and smoking worsen the crease.
- Structural factors: chin projection and dentition can worsen or soften the appearance.
The diagram on this page shows the area in line art. Understanding the layers helps explain to the patient why the approach covers the whole area.
Two types of line: dynamic and static
| Type | How it appears | Who usually takes part |
|---|---|---|
| Dynamic | Appears or worsens with expression, such as when lowering the mouth | Depressor anguli oris muscle |
| Static | Present at rest, like a crease | Volume loss, skin, laxity |
| Mixed | Both behaviors | A combination of causes |
This difference guides the choice. A dynamic line may benefit from adjusting the muscle action; a static one calls for volume replacement or skin stimulation; a mixed one requires both strategies, at the professional's discretion.
Softening options
The options below are not a recommendation, but the range a qualified professional considers, according to the rules of their professional council in Brazil.
- Filler with hyaluronic acid: restores volume and support at the corner of the mouth and around it, softening the shadow. It calls for attention to the vessels and to the relationship with the muscle and the mucosa.
- Botulinum toxin: in selected cases, reduces the action of the muscle that pulls the corner down, with a risk of affecting function if poorly indicated.
- Collagen biostimulator: improves quality and support over months, subtly.
- Treating the whole area: chin, jowl, and prejowl sulcus, when they contribute to the look.
- Skin care: sun protection and a routine that improves texture, without promising to erase the crease.
For comparison with the other fold, see smile lines: what softens them and deep fold: filler or threads. And for a downturned mouth corner, drooping mouth corners.
How to plan
Specific risks
Besides the risks of any injectable, the area has nearby vessels, such as branches of the facial artery, and the mobility of the mouth makes irregularities more likely. With toxin, excess can cause an asymmetric smile or difficulty speaking and holding liquids. See crooked smile after botox and drooping mouth corners.
How to talk to the patient
Record the plan and instructions in the patient record and in the informed consent.
Frequently asked questions
What are marionette lines?
They are folds that run down from the corners of the mouth toward the chin, giving a sad or tired look to the mouth. They appear over time, from loss of support and muscle action.
Can marionette lines be treated?
Yes, with options such as filler, biostimulator and, in selected cases, toxin in the depressor muscle. The choice depends on the cause, the depth, and the professional's assessment.
Does filling only the marionette line solve it?
Not always. The line is usually part of a set that includes the mouth corner, the prejowl sulcus, and the support of the face. Treating only the line may give a limited result.
Are marionette lines the same as smile lines?
No. Smile lines are the nasolabial folds, which run from the nose to the corner of the mouth. Marionette lines start at the corner of the mouth and run down toward the chin.
Harmy images are illustrative simulations generated by AI from the patient's photo to support the conversation between practitioner and patient. They are not a promise of results. Indication, technique, product and volume are solely the decision of the licensed practitioner. This content is for information only and does not replace a clinical assessment.